Subject:  New Prior Authorization Form Available Soon  
Date:  November 12, 2021
We will be updating our prior authorization process very soon. We are standardizing our current Prior Authorization Form so that certain aspects of the process can now be automated. This will ensure a faster, more efficient prior authorization approval process.

We estimate that this new form will be available December 2021. To comply with this new process, providers must begin filling out the new form and removing the old form from service when the new form is available.

The form that must be filled out to submit a prior authorization request will be changing. The fax number for the prior authorization process will remain the same. The form will still be located in the same section of our website in Provider Forms.

We appreciate your commitment to our members and their health care needs.  

Call Provider Services at 1-855-232-3596 (TTY: 711) if you have any questions.